Sunrise Medical SMA manual

18

maybe years. A contoured back, on the other hand, provides more contact surface therefore more comfort.

In general, the more contour, the less freedom of movement – which may make contoured backs somewhat more appropriate for children with low trunk control, as they provide more support. Children with SMA also tend to prefer softer materials on both the seat and the back - to get a “hugging feeling” – which makes for a more pleasant sensory experience. As with cushions, the selection of backrests is very wide, and many companies offer custom fabricated backrests. Typically most wheelchair frames interface with most seating systems.

Footrests:

Footrests can flip up or swing out of the way to ease transfers. They may be height and angle adjustable to accommodate contractures of the foot.

Headrest:

For a user with poor head control proper support is needed. Head supports vary widely from thin well targeted pads to softer larger surfaces. If you are going to use recline and a very supportive headrest, a shear reducing backrest is definitely recommended to keep the headrest in position relative to the head.

At least a simple headrest is typically prescribed, as it tends to be a requirement on school buses for transportation.

Lateral supports and hipguides:

These accessories are often utilized to help the hips and the trunk to maintain midline, or whatever the user’s comfort position is. Some are available with summer/winter hardware, which means you can easily vary the width depending on how thick clothing your child wears. They also come in swing-away or removable hardware, to ease transfers.

Belts and harnesses:

Seat belts, chest belts, footstraps and anterior chest harnesses (butterfly harnesses) are available in a variety of materials and sizes. These accessories help some children maintain position in their wheelchairs as well as ensure safety. For example, a power wheelchair user with low tone in the trunk may easily pitch forward at a sudden stop, so a chest strap may be needed to help maintain trunk position. A seat belt (pelvic belt, lap belt) is typically prescribed with any wheelchair to ensure safety. Footstraps are often prescribed to help maintain foot positioning and prevent contractures.

These devices may be preventive and safe, but their over-utilization can be counter effective. They restrict movement and are not aesthetically pleasing. In addition all caregivers need to be instructed of their proper use. If the straps will be worn throughout the day tightly, it is recommended to look at padded, stretchy options to improve comfort. It is important to realize that the major negative factor in seating is gravity, which can not be counter-effected easily. Sometimes tilt and other seat functions are much more effective than straps in maintaining posture.

Shoulder harnesses are also often required by school transportation, even though they are not approved transportation safety devices.